Risk Factors for Sexual Violence Against Girls and Associated Mental Health Outcomes in Young Adulthood: A Multi-Country Study

Sexual violence (SV) is a major global public health and human rights problem. Globally, studies have shown that SV against girls is not uncommon. Efforts to drive prevention and policy strategies to address the global burden of violence against girls can benefit from rigorous, population-based data. The present study used data from the Violence Against Children Surveys (VACS) from ten countries, Swaziland, Tanzania, Kenya, Haiti, Malawi, Zimbabwe, Cambodia, Nigeria, Zambia, and Uganda. VACS are national household surveys of youth ages 13-24 that measure the burden, risk factors, and context of violence in childhood, adolescence, and young adulthood. Nationally representative samples and weights yield population prevalence data; sample sizes range from 1,244 females in Swaziland to 3,159 females in Uganda. Across 10 countries, the lifetime prevalence of childhood SV among girls ranges from 4% (Cambodia) to 38% (Swaziland). Analyses of individual, and family risk factors for SV used data from Swaziland, Tanzania, and Uganda. Significant risk factors for SV included having no relationship or not a close relationship with one’s mother (OR: 1.89; 95% CI: 1.14–3.14), not attending school (OR: 2.26; 95% CI: 1.70–3.01); and emotional abuse prior to age 13 (OR: 2.04; 95% CI: 1.50–2.79). Having worked for pay in childhood, socioeconomic status, religion, and orphan status were not significantly associated with experiencing childhood SV. Analyses across 10 countries assessed the relationship between childhood SV and young adult mental and physical health. After adjusting for educational status, orphan status, and relationships with mothers, childhood SV was associated with significantly increased odds of depression (AOR: 2.31; 95% CI: 1.70-3.11), suicidal ideation (AOR: 2.31; 95% CI: 1.57-3.40), sexually transmitted infection symptoms or diagnoses (AOR: 2.69; 95% CI: 1.78-3.66), and alcohol abuse (AOR: 3.02; 95% CI: 1.68-5.44) in young adults. Childhood SV was not significantly associated with tobacco or drug use in young adulthood. Identifying subgroups of girls at greatest risk of SV can inform efforts to target prevention programming to the most vulnerable groups. Knowledge of the high prevalence of childhood SV globally and its associated serious health-related conditions can inform effective prevention strategies.